OBJECTIVES: 

To investigate national mortality trends over a 12-year period for patients with severe acute pancreatitis (SAP) admitted to Dutch ICUs. Additionally, an assessment of outcome in SAP was undertaken to differentiate between early (< 14 d of ICU admission) and late (> 14 d of ICU admission) mortality.

DESIGN: 

Data from the Dutch National Intensive Care Evaluation and health insurance companies’ databases were extracted. Outcomes included 14-day, ICU, hospital, and 1-year mortality. Mortality before and after 2010 was compared using mixed logistic regression and mixed Cox proportional-hazards models. Sensitivity analyses, excluding early mortality, were performed to assess trends in late mortality.

SETTING: 

Not applicable.

PATIENTS: 

Consecutive adult patients with SAP admitted to all 81 Dutch ICUs between 2007 and 2018.

INTERVENTIONS: 

Not applicable.

MEASUREMENTS AND MAIN RESULTS: 

Among 4,160 patients treated in 81 ICUs, 14-day mortality was 17%, ICU mortality 17%, hospital mortality 23%, and 1-year mortality 33%. After 2010 in-hospital mortality adjusted for age, sex, modified Marshall, and Acute Physiology and Chronic Health Evaluation III scores were lower (odds ratio [OR], 0.76; 95% CI, 0.61–0.94) than before 2010. There was no change in ICU and 1-year mortality. Sensitivity analyses excluding patients with early mortality demonstrated a decreased ICU mortality (OR, 0.45; 95% CI, 0.32–0.64), decreased in-hospital (OR, 0.48; 95% CI, 0.36–0.63), and decreased 1-year mortality (hazard ratio, 0.81; 95% CI, 0.68–0.96) after 2010 compared with 2007–2010.

CONCLUSIONS: 

Over the 12-year period examined, mortality in patients with SAP admitted to Dutch ICUs did not change, although after 2010 late mortality decreased. Novel therapies should focus on preventing early mortality in SAP.

中文翻译：

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入住 ICU 的重症急性胰腺炎患者的早期和晚期死亡率趋势：一项全国队列研究

目标： 

调查荷兰 ICU 收治的重症急性胰腺炎 (SAP) 患者 12 年期间的全国死亡率趋势。此外，还对 SAP 的结局进行了评估，以区分早期（入住 ICU 14 天以下）和晚期（入住 ICU 14 天以上）死亡率。

设计： 

从荷兰国家重症监护评估和健康保险公司的数据库中提取数据。结果包括 14 天、ICU、医院和 1 年死亡率。使用混合逻辑回归和混合 Cox 比例风险模型比较 2010 年之前和之后的死亡率。进行敏感性分析（排除早期死亡率）以评估晚期死亡率的趋势。

环境： 

不适用。

患者： 

2007 年至 2018 年间，荷兰 81 个 ICU 连续收治 SAP 成年患者。

干预措施： 

不适用。

测量和主要结果： 

在 81 个 ICU 接受治疗的 4,160 名患者中，14 天死亡率为 17%，ICU 死亡率为 17%，住院死亡率为 23%，1 年死亡率为 33%。2010 年之后，根据年龄、性别、改良马歇尔评分、急性生理学和慢性健康评估 III 评分进行调整后的院内死亡率低于 2010 年之前（比值比 [OR]，0.76；95% CI，0.61–0.94）。 ICU 和 1 年死亡率的变化。排除早期死亡患者的敏感性分析显示，ICU 死亡率降低（OR，0.45；95% CI，0.32-0.64），住院死亡率降低（OR，0.48；95% CI，0.36-0.63），1 年死亡率降低（风险比，0.81；95% CI，0.68-0.96）2010年后与2007-2010年相比。

结论： 

在 12 年的研究期间，荷兰 ICU 收治的 SAP 患者的死亡率没有变化，尽管 2010 年之后晚期死亡率有所下降。新疗法应侧重于预防 SAP 的早期死亡。